Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 38MC00467300 | NJ |
NPI | 1225431182 |
---|---|
Provider Name | Debra Maibach |
First Address | Basking Ridge, NJ 07920-1158 |
Second Address | Stirling, NJ 07980-1346 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2014 |
Last Update Date | 06/10/2014 |